“Many People Taking Antidepressants Discover They Cannot Quit”
Does this headline concern you? If you read the accompanying article in the New York Times and you’re on medication for anxiety or depression, you might feel alarmed. And if you’ve decided to start a medication regimen, you might even change your mind.
The article reflects a bias many people still harbor towards mental health issues and medication: you should be able to deal with your problems by force of will; if you can’t just get on with it, you’re weak. As the Times article suggests, “Daily pill-popping leaves them doubting their own resilience…” Pill-popping? Seriously?
No medication is completely benign. Yet few would question taking drugs commonly prescribed for high blood pressure, seizures, muscle cramps, and infections, many of which can have discontinuation side effects. Clearly, a double standard applies to the pharmacological treatment of psychiatric conditions..
The writer acknowledges that “many, perhaps most, people stop the medications without significant trouble,” but then goes on to relate the personal anecdotes of a handful of individuals who attributed “all the symptoms of withdrawal,” including increased anxiety and insomnia, to medication discontinuation. He neglects to point out one of the most common reasons for deciding to go back on medications for anxiety and depression after trying to come off them: a resurgence of the symptoms being treated.
It’s true, as the article points out, that primary care physicians write the vast majority of prescriptions for antidepressant and antianxiety medications. Follow-up is not as rigorous as it should be, and office visits are typically too short for an adequate assessment of mood changes and side effects. But it’s very misleading to assume, as the writer does, that “a useless [my emphasis] prescription may be continued for years—or a lifetime” because “improvement…is based on the passage of time or placebo effect.”
I’m not in the pocket of Big Pharma. I can’t prescribe medication. I don’t get a kickback from my psychiatrist colleagues for referring patients to them. When someone in my practice expresses a preference for trying cognitive-behavioral therapy without medication, I’m more than happy to oblige—with the understanding that we’ll revisit the decision at a later date if the therapy yields less-than-optimal results.
I believe in helping people find the maximally effective treatment for them. If that means recommending a trial of medication, I’ll suggest a referral to a psychiatrist who can address their concerns fully, monitor them regularly, and work with me to provide the best care.
Medication isn’t a magic bullet. But it can be a powerful tool. Making any health care decision should involve weighing the costs and benefits–with the help of professional guidance and not anecdotal horror stories–to determine the course of treatment.
OCD is like an opportunistic pathogen, invading hosts with weakened immune systems. So it’s not surprising to see it thrive and spread when daily news reports stoke uncertainty and fear in those who are vulnerable.
The recent spate of revelations about sexual misconduct among the rich and famous, along with controversial reports in the last few years of a campus rape crisis, have brought a new demographic into my practice: young men in their twenties who worry about committing or having committed a sexual transgression.
Some of these men have been accused—and all exonerated—of inappropriate touching, nonconsensual or consensual but inappropriate sex with colleagues, students, or classmates; others live in fear of having a casual sexual encounter from their past surface and become fodder for an accusation.
OCD is having a field day.
As reporter Emily Yoffe chillingly details in a series of articles in The Atlantic , Obama-era federal directives governing the handling of sexual-assault allegations have prompted universities to craft vague and overarching definitions of sexual assault designed to protect the (mostly) female victims while stripping the accused of their right to due process. The Kafkaesque scenarios Yoffe describes—such as a third party accusation in which a friend reported her roommate’s boyfriend as an abuser and the alleged victim, refuting the claim, was told she was in denial– create the perfect medium for OCD to flourish.
Let me be perfectly clear. I am in no way minimizing the trauma experienced by assault victims. I believe charges of rape on college campuses should be taken very seriously. They should be investigated thoroughly and, if the evidence points to a crime, prosecuted in a court of law. And I am not excusing the predatory behavior of the Harvey Weinsteins who have abused their power to intimidate and sexually exploit women.
But the men with OCD I see in my practice are not predators or rapists. In fact, most share two thinking patterns common in people with OCD: an excessive sense of responsibility and a highly developed sense of morality. They worry about causing harm and about being bad people even though, in the paradoxical way of OCD, they’re actually good people with a strong—perhaps even excessively rigid—moral compass.
So, no, I don’t secretly question if they might have done what they’ve been accused of or fear being accused of, just as I know with a reasonable degree of certainty that the people with OCD who confess to me their fears of being pedophiles are not a danger to children.
As with all OCD worries, however, facts and probability do little to assuage anxiety. So the challenge is to acknowledge the possibility of a dreaded occurrence—such as a false accusation–while not letting fear get in the way of living.
While it’s hard to push back, I can recommend a few guidelines to follow if you’re consumed by worries of being unjustly accused of sexual assault.
Shakespeare said, “Misery acquaints a man with strange bedfellows.” Resist the temptation to lie down with OCD.
My newly rescued terrier Dewey is, in almost all ways, an excellent dog. He’s energetic, inquisitive, friendly, and affectionate. But when we’re out walking and he spies another dog, he turns into a whirling, barking Tasmanian Devil. Luckily he weighs only eighteen pounds—any bigger and he’d knock me off my feet. Still, the prospect of a surprise canine encounter made me dread our daily outings.
So I signed up for a Distracted Dog class. I already had been working on undoing some of the bad habits Dewey had acquired over the seven years of his life before coming to us. He’s learning how to wait for his food, lie down instead of jumping up and begging, and walk on a leash without pulling. The challenge now is to keep his attention on me in more stressful situations.
Before the first day of class, our instructor asked us to send her a hierarchy of our dog’s top five distractions, much like the hierarchy of anxiety triggers used in CBT for exposure and response prevention. At the top of Dewey’s list was “seeing another dog approach while on a walk.”
In treating anxiety, I help people stop avoiding and start approaching what they most fear. I needed to apply the same mindset to changing my dog’s (and my own) reactions to the stimuli that send him into a frenzied display of doggie frustration.
So, instead of anxiously scanning the environment for other dogs in order to do an about face before Dewey spots them, I’ve started looking for ways to practice building his self-control. As a result, I’ve observed a dramatic change in my own (if not yet Dewey’s) emotional reaction. I’m excited instead of tense when I see neighbors out walking their dogs. I now interpret a potential trigger not as a threat to steer clear of but as an opportunity to seek out.
If I were drawing only from my personal experience, my method wouldn’t carry much weight. But the results of several research studies support my anecdotal evidence. Saying, “I feel excited” instead of attributing physical arousal to anxiety—a technique called “anxious reappraisal”—can improve singing, test-taking, and public speaking performance by putting people in an “opportunity mindset” even though the physiological markers of anxiety such as increased heart rate and cortisol levels remain elevated.
In fact, you don’t even need to tell yourself you’re excited; just believing that anxiety can improve rather than impair performance helped test takers score higher on the GRE. It’s a trick actors often use to cope with stage fright. Those who are successful don’t necessarily feel less nervous. But they’re able to view the fluttering of their hearts and rumbling of their stomachs as feelings that give energy to their performance.
Confronting anxiety is hard. You can’t make progress unless you’re willing to face the situations you fear. But changing the way you think about arousal might make it a little easier to rise to the challenge.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.